CSFP Monthly Reporting
When you sit down to complete the form, be sure all your documents are ready for submission. If all documents are downloaded and saved somewhere on your computer, it will allow for a quick and efficient submission. Remember only PDFs, Excel sheets, and Word documents are allowed to be submitted. If you have questions while completing this form, please call Dana Carhart at 757-201-6284 between the hours of 8 am-4:30 pm.
Agency Name & Number:
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Please Select
PA0470- Childs Foundation
A0003- Oasis Social Ministries
A0013- Grace Lutheran Church
A0050- Plummer Plaza Senior Living
A0195- Kemet House
A0284- Bank Street Baptist Church
A0306- East End Baptist Church
A0487- Grace Place
A0138- IOW Christian Outreach Program
A0618- 618 South St Food Hub
A0752- Jordan Newby
A0789- Silver Tree
AES032- Pungoteague
AMPC3- Cambridge Square
AMPCSFP0- Isabella Health Foundation
AMPF5- Springdale
AMPES18- Peter Cartwright
Full Name
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Phone Number
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Month
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Year (i.e. 2025 - enter 4 digits)
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Basic Info & Box Number Reporting
What was the total number of CSFP boxes you received from the Foodbank this month?
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Be sure to count the boxes when they arrive AND THEN compare that number to the invoice. Please save all invoices. This is when you should refer back to them if needed.
What was the total number of boxes distributed at your site this month?
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What is the total remaining inventory (leftover boxes/boxes not distributed)?
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How many CSFP boxes were damaged?
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How many CSFP cheeses were damaged?
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Please upload pictures of any damaged foods reported above.
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CSFP Training Documents:
Any volunteers who participate in the dissemination of CSFP boxes must be trained in Civil Rights annually. If you have trained any volunteers, they must read and sign "thisdoc." These documents do not need to be submitted. They MUST however be stored on site.
Did you train any volunteers/people who helped you at this month's CSFP distribution?
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Yes
No
Site Coordinator's Annual CSFP Volunteer Training Log
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Please upload a pdf photocopy of the Volunteer Training Log you received at training. This page should show any volunteers you have trained in CSFP
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Do you have any other volunteers you havent trained yet?
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Yes
No
If yes, how many volunteers do you have left to train in CSFP?
CSFP Storage Documentation:
If you store CSFP boxes for 12 or more hours, you must keep temperature logs for dry storage and refrigeration units. You must check the temperature of these rooms three times a week and document accordingly. The only documents that can be submitted are PDFs, Excel sheets, and Word documents.
Do you have a Foodbank approved storage space for CSFP boxes?
Yes
No
Temperature Log (File name: Agencyname.templog.M.YYYY)
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Monthly Distribution Sheet Submission
Your CSFP distribution sheet should show month, year, number of boxes delivered, number of boxes distributed and number of boxes left over. It should show who out of your list received a box for the month and who missed pickup. The only documents that can be submitted are PDFs, Excel sheets, and Word documents.
CSFP Monthly Distribution Check Off Sheet
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If you're not submitting a Word/Excel document, use a phone app to scan your photo and convert it into a PDF BEFORE submitting. Your distribution check off sheet upload MUST contain your waitlist. The waitlist must be visable in your upload/submission.
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CSFP Application Section:
Please be sure the eligibility verification section and the signature section at the bottom of the application is completed. A corresponding letter must be submitted, given to the senior, and filed with your site's records. The only documents that can be submitted are PDFs, Excel sheets, and Word documents. Application file names must be: "lastname.firstname.certificationdate." REMEMBER: applications are NEVER submitted without an accompanying CSFP letter.
Did you receive any new filled out CSFP applications? (REMEMBER: a matching CSFP letter should also be submitted in section below).
Yes
No
Completed Application(s) (File name: Lastname.Firstname.app.M.DD.YYYY)
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Ensure the bottom back of the application has been completed.
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Use this space to list out status of each application uploaded above, as either a new application, a recertification or for a senior that has applied and been waitlisted. (Ex: Jon Doe-waitlisted, Jon Doe-active, Jon Doe- recertified).
If they're all waitlisted applications, please note that here. If they're all recertifications say: "all the applications uploaded are recertifications."
CSFP Letters
If you've accepted any applications this month, they MUST have a matching CSFP letter uploaded here. Please upload copies of any/all acceptance letters, discontinuation letters, ineligibility letters, or recertification letters sent or given out to seniors this month. Please ensure letters are uploaded here. After doing so, please file them in a safe place.
Did you send/hand deliver any CSFP letters this month?
Yes
No
Letters Sent This Month (File name: Lastname,firstname.Acc/Dis Lett D.M.YYYY)
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If you have accepted ANY CSFP applications from seniors this month, their MUST be an accompanying CSFP letter submitted here AND sent to senior.
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